Barriers to employment for people with

severe mental illness and criminal

justice involvement

Vigdis Sveinsdottir & Gary R. Bond

To cite this article: Vigdis Sveinsdottir & Gary R. Bond (2017): Barriers to

employment for people with severe mental illness and criminal justice involvement, Journal of

Mental Health

To link to this article: https://doi.org/10.1080/09638237.2017.1417556

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ORIGINAL ARTICLE

Barriers to employment for people with severe mental illness and criminal justice involvement

Vigdis Sveinsdottir1 , and Gary R. Bond2

1Uni Research Health, Uni Research, Bergen, Norway and 2Westat, Lebanon, NH, USA

Abstract

Background: People with severe mental illness (SMI) and criminal justice involvement (CJI) are able to achieve competitive employment when provided with evidence-based services, but outcomes are modest compared to studies of SMI in general. Aims: To investigate barriers to employment facing people with SMI and CJI receiving employment services. Method: Employment service providers assessed top three barriers to employment for 87 people with SMI and CJI enrolled in a randomized controlled trial comparing a job club program to supported employment. Main barriers were identified and differences between programs were analyzed. Associations between barriers and client background characteristics were investigated. Results: The most common barriers were failure to engage and disengagement from services, followed by substance abuse. Staff from the two employment programs reported similar barriers. Conclusions: Engagement problems were the single most important barrier to employment across

programs. Surprisingly, criminal history was rarely mentioned. This may be explained by barriers

arising earlier in the process, before achieving employer contact. The results call for recognition

and awareness of the importance of motivational issues as well as factors that may inhibit

engagement in services, highlighting possible augmentations to evidence-based employment

services that may be necessary in the rehabilitation of this patient group.

Keywords

Severe mental illness, criminal justice, supported employment, individual placement and support, barriers

History

Received 19 September 2016 Revised 12 July 2017 Accepted 3 October 2017 Published online 21 December 2017

Introduction

Despite a large and growing body of research showing that

people with severe mental illness (SMI) can obtain competitive

employment when provided with evidence-based employment

services (Marshall et al., 2014) the unemployment rate for this

group is as high as 90%, constituting the highest

unemployment level of any disability group (Bond & Drake,

2014). Meanwhile, people with SMI are overrepresented in the

criminal justice system (Prins, 2014). Stable employment is a

critical predictor of post-release success, but people with

criminal justice involvement (CJI) often have little work

experience and lack work skills (Visher et al., 2005). Lacking

employment services or job opportunities, ex-offenders are

often released without any assistance for community living and

consequently face large obstacles to reintegration upon release

(Harrison & Schehr, 2004). In the United States, employment

programs for ex-offenders are rare (Solomon et al., 2004), and

existing programs have typically involved traditional

vocational rehabilitation approaches including job clubs

(Bellotti et al. 2008; LePage et al. 2013) and various pre-

vocational training programs (Anderson & Schumacker, 1986;

Sabol, 2007), sometimes in combination with offers of

temporary jobs or apprenticeships (Hamilton & McKinney,

1999; Redcross et al., 2012; Schaeffer et al., 2014; Uggen,

2000) or job placement services (Finn, 1998; Mallar &

Thornton, 1978; Menon et al., 1992; Rossi et al., 1980;

Rossman et al., 1999; Schochet et al., 2001). The effectiveness

of these services is mostly unknown due to a lack of adequate

evaluations (Visher et al., 2005).

The Individual Placement and Support (IPS) model of

Supported Employment is an evidence-based model of

employment services for people with SMI (Marshall et al.,

2014). Conceptualizing employment as part of mental health

treatment, IPS focuses on regular jobs in the competitive labor

market and incorporates eight evidence-based principles:

eligibility based on client’s choice, focus on competitive

employment, rapid job search, attention to client preferences,

systematic job development, integration of mental health and

employment services, individualized benefits counseling and

individualized long-term support (Drake et al., 2012). The

model has been widely implemented in the US (Becker et al.,

Correspondence: Vigdis Sveinsdottir Uni Research Health, Uni Research,

Bergen, Norway. Tel: þ47 55 58 99 59. E-mail: vigdis.sveinsdottir@uni.no

2 V. Sveinsdottir & G. R. Bond J Ment Health, Early Online: 1–9

2014) as well as internationally (Bond et al., 2012), but only

one controlled trial has examined the effect of IPS specifically

for people with SMI and CJI (Bond et al., 2015). While this

study showed that participants receiving IPS were over four

times more successful in obtaining competitive employment

than a control group receiving a traditional job club

intervention (31% vs. 7%), the outcomes were modest

compared to previous IPS studies of people with SMI in

general (Bond et al., 2015).

Studies of various populations with mental illness indicate

that common barriers to employment include symptoms of

mental illness (Kukla et al., 2016; Milfort et al., 2015; Noel et

al., 2017; Poremski et al., 2016), physical illness (Braitman et

al., 1995; Kukla et al., 2016; Milfort et al., 2015), substance

abuse (Braitman et al., 1995; Kukla et al., 2016; Poremski et

al., 2016), demographic factors such as race and poverty

(Cook, 2006; Hanisch et al., 2017; Rosenheck et al., 2006),

stigma (Bassett et al., 2001; Cook, 2006; Henry & Lucca,

2004; Tschopp et al., 2007) and lack of motivation or

engagement (Braitman et al., 1995; Milfort et al., 2015; Noel

et al., 2017; Poremski et al., 2016). Compared to those with

physical disabilities, individuals with mental illness are more

likely to report barriers that are not health-related, such as

being unable or discouraged from finding a job, lacking skills

or being dismissed (Sevak & Khan, 2017). Employment

services for people with CJI do, however, face additional

challenges that are unique to this group, and employment

specialists identify addressing criminal justice issues as one of

their greatest challenges (Whitley et al., 2009). Hiring policies

and criminal background checks restrict employment for

people with criminal records (Blumstein & Nakamura, 2009;

Walter et al., 2016), and legal restrictions prohibit employment

of people convicted of specific offenses within various job

settings and locations (Harrison & Schehr, 2004; Walter et al.,

2016; Whitley et al., 2009). Existing stigma toward mental

illness (Thornicroft, 2006) may be amplified in combination

with a criminal background, creating additional barriers to

employment (Tschopp et al., 2007). Initiatives aimed at

overcoming criminal background questions in employment

processes may be undermined by discrimination of observable

demographic characteristics of exoffenders (Solinas-Saunders

et al., 2015). This group also commonly faces barriers related

to limited education, cognitive skills and work experience

(Holzer et al., 2003; Morris et al., 2008; Tonkin et al., 2004),

are more likely to be homeless or drug-dependent (Theriot &

Segal, 2005), and take longer to access employment services

due to barriers related to the legal system (such as terms of

mental health probation), psychosocial functioning, lack of

social networks and low expectations from clients themselves

as well as their practitioners (Frounfelker et al., 2010).

Qualitative studies further illustrate the hopelessness and

resignation experienced by this group, with job opportunities

being closed to them due to their criminal background (Baron

et al., 2013).

Objective

Identifying specific challenges in vocational rehabilitation

efforts toward people with SMI and CJI is necessary in order

to target services and develop strategies to address these

barriers. The current study is a secondary analysis of a

randomized controlled trial of employment services for this

client group (Bond et al., 2015). We examined barriers to

employment for clients enrolled in two employment programs,

hypothesizing that a main barrier across programs would be

related to CJI and difficulties achieving acceptance of clients

with criminal justice histories by employers during the job

search process.

While previous literature on barriers to employment among

people with SMI and CJI has been based on interviews and

focus groups (Frounfelker et al., 2010; Tschopp et al., 2007;

Tschopp et al., 2011; Whitley et al., 2009), this study used

quantitative data on barriers reported by the providers of

employment services, investigating specific client

characteristics that practitioners viewed as main barriers in the

process of attaining employment. Addressing these specific

barriers in the vocational rehabilitation of this group may be a

viable way to increase labor market participation and

overcome the social exclusion and lack of membership in

society experienced by this highly marginalized population.

Methods

Parent study

The current study uses data from the first randomized

controlled IPS trial for justice-involved clients (Bond et al.,

2015). The study compared clients randomly assigned to two

contrasting approaches to helping people gain employment.

One group received IPS following the eight model principles

as described earlier, provided by employment specialists who

had received one day of additional training in criminal

justicerelated issues. The comparison group received a

program labeled Work Choice, a traditional job club approach

(Azrin & Philip, 1979) adapted for people with SMI (Corrigan

& Reedy, 1995). This approach involved helping participants

prepare re´sume´s and practice for job interviews (including

disclosure of criminal history), and a self-directed job search

approach utilizing peer support, job leads and referrals to

employers known to hire people within this group. Participants

were followed for one year, and data were collected using face-

to-face interviews, medical and employment records, and

information from individual service providers.

Participants

The sample consisted of 87 people with SMI and CJI.

Participants were recruited through Thresholds, a large

psychiatric rehabilitation organization providing recovery

services for people with SMI in the Chicago area.

Sample inclusion criteria were: receiving mental health and

case management services at Thresholds, at least 18 years of

age, no competitive employment in the past three months, no

DOI: 12.1080/09638237.2017.1417556 Barriers to employment in SMI and CJI 3

prior involvement in IPS services, SMI (including diagnosis of

schizophrenia spectrum disorder, major depressive disorder,

bipolar disorder or other psychotic disorder, with either

significant treatment history or significant functional

impairments), self-disclosed criminal justice history,

expressed interest in competitive work, no restriction (legal,

physical or other) that would prevent participation over a 12

month follow-up period, and attendance at two informational

groups.

Measures

Background measures and possible predictors

Demographic and background information was gathered at

baseline through participant interviews and medical and

employment records. This included age, gender, race, marital

status, education, housing, psychiatric diagnosis (as

determined by a psychiatrist using DSM-IV criteria),

substance use diagnosis (clinical-rated scales (Drake et al.,

1996) or chart diagnoses), employment history and income

status (Dartmouth Employment and Income Review (Drake et

al., 1996)), and criminal justice history (number of times being

arrested, number of times being incarcerated and seriousness

of convictions (felonies or misdemeanors)).

Recovery assessment

Self-reported recovery was measured at baseline through

participant interviews, using the 24-item Recovery

Assessment Scale (RAS) (Corrigan et al., 2004), measuring

personal confidence and hope (11 items, ¼0.90), willingness

to ask for help (3 items, ¼0.82), goal and success orientation

(3 items, ¼0.64), reliance on others (4 items, ¼0.69) and not

being dominated by symptoms (3 items, ¼0.68). Items were

rated on a 5-point scale from 1

(strongly disagree) to 5 (strongly agree), with higher values

indicating increasing recovery assessments.

Satisfaction with services

Satisfaction with vocational services was assessed at 12month

follow-up through participant interviews, with a single item

asking participants ‘‘How satisfied are you with the vocational

services you are receiving at Thresholds?’’ Responses were

rated on a 4-point scale from 1 (very satisfied) to 4 (very

dissatisfied). The scores were reversed in order for higher

values to indicate increasing satisfaction.

Barriers to employment

Near the end of the study, the staff from the two vocational

programs identified the top three barriers to employment for

each participant by, using a 16-item Barriers to Employment

Checklist, adapted from a checklist used in a previous study

(Milfort et al., 2015). The checklist included descriptions and

examples of the various barriers (Appendix A), which

concerned: failure to engage in vocational services,

disengagement from vocational services, physical health

problems, substance abuse or dependence, symptoms of

mental illness, cognitive problems, family problems, gap in

services, e.g. case management, transportation, lack of

prerequisites for work, lack of social skills, criminal justice

system problems, housing problems/homelessness, behavior

problems, benefits and a don’t know/open category. The staff

on the two vocational programs (employment specialists in the

IPS condition and the program coordinator leading the training

in the work choice condition) were instructed to select up to

three top barriers for each participant, and provide information

and documentation of how each of these barriers interfered

with obtaining employment. Barriers were rated as first,

second or third based on perceived importance.

Analyses

Frequencies of reported primary, secondary and tertiary

barriers to competitive employment were analyzed for the total

sample. Data for primary, secondary and tertiary barriers were

then aggregated, and frequencies were analyzed for the total

sample and by study groups. Differences between the groups

were analyzed using a series of chi-square tests for each item.

We examined associations between the most common

barriers and client background characteristics, recovery

assessment and satisfaction with services, using chi square

tests for independence (binary variables) and independent t-

tests (continuous variables).

Results

Ranking of reported barriers

Table 1 shows the distribution of primary, secondary and

tertiary barriers. An additional category termed ‘‘no job goal’’

was added based on free responses in the open category.

Failure to engage and disengagement in vocational services

were the two most common primary barriers, followed by

substance abuse. At least one of these barriers was reported as

the primary barrier to competitive employment for 43 (49.4%)

participants.

Frequency of reported barriers

Table 1 also shows the distribution of barriers in the total

sample and in each study condition. Failure to engage and

disengagement in vocational services was the most frequently

reported barriers, followed by substance abuse. The

employment teams reported at least one of these three barriers

for 79 (90.80%) of the participants.

Findings were generally consistent across study groups,

with the exception of ‘‘no job goal’’, which was more common

in the work choice (n¼8, 18.20%) than the IPS (n¼1, 2.30%)

condition (N¼87, 2¼5.90, df¼1, p¼0.03, phi¼.26). The exact p

value (Fisher’s exact test) was used because two cells had an

expected count less than five.

Engagement problems: possible predictors

Participants with either failure to engage or disengagement

reported as a barrier were compared to the remaining

participants on background variables and possible predictors

(Table 2). Those who reported engagement problems were less

4 V. Sveinsdottir & G. R. Bond J Ment Health, Early Online: 1–9

satisfied with the vocational services received (r¼0.29) and

were convicted of more serious crimes (phi¼0.22).

Engagement problems were also associated with higher scores

on the RAS subscale of being more dominated by symptoms

(r¼0.28), and less often with a diagnosis of schizophrenia

(phi¼0.27).

Discussion

The main barriers to obtain competitive employment among

people with SMI and CJI receiving employment services

concerned engagement problems, followed by substance

abuse.

Table 1. Barriers to competitive employment, by ranking, total, and by group, and chi-square test of independence.

Primary barrier Secondary barrier Tertiary barrier Total (N¼87) IPS (n¼43) Work choice (n¼44) Chi squarea

Barrier N

% N

% N

% N

% N

% N

% 2 p

Failure to engage 22 25.3 5 5.7 3 3.4 30 34.5 16 37.2 14 31.8 0.28 ns

Disengagement 12 13.8 11 12.6 7 8 30 34.5 18 41.9 12 27.3 2.05 ns

Substance abuse 9 10.3 8 9.2 2 2.3 19 21.8 9 20.9 10 22.7 0.04 ns

Physical health problems 6 6.9 7 8 2 2.3 15 17.2 9 20.9 6 13.6 0.81 ns

Lack of prerequisites 8 9.2 4 4.6 2 2.3 14 16.1 4 9.3 10 22.7 2.90 ns

Criminal justice problems 6 6.9 4 4.6 3 3.4 13 14.9 5 11.6 8 18.2 0.73 ns

Mental health problems 5 5.7 5 5.7 2 2.3 12 13.8 7 16.3 5 11.4 0.44 ns

No job goal 2 2.3 6 6.9 1 1.1 9 10.3 1 2.3 8 18.2 5.90 0.02

Family problems 2 2.3 4 4.6 2 2.3 8 9.2 5 11.6 3 6.8 0.60 ns

Cognitive problems 5 5.7 0 - 1 1.1 6 6.9 3 7 3 6.8 0.00 ns

Lack of social skills 3 3.4 2 2.3 1 1.1 6 6.9 1 2.3 5 11.4 2.77 ns

Fear of losing benefits 3 3.4 1 1.1 1 1.1 5 5.7 3 7 2 4.5 0.24 ns

Behavior problems 0 - 1 1.1 2 2.3 3 3.4 3 7 0 - 3.18 ns

Don’t know 1 1.1 1 1.1 1 1.1 3 3.4 2 4.7 1 2.3 0.37 ns

Housing problems 0 - 2 2.3 0 - 2 2.3 0 - 2 4.5 2.00 ns

Transportation 0 - 0 - 1 1.1 1 1.1 1 2.3 0 - 1.04 ns

Gap in services 0 - 0 - 0 - 0 - 0 - 0 - - - a For cells with expected cell count less than 5, exact p values (Fisher’s exact test significance) were used. 0.02 (indicated in bold) is the p-value of the chi square test for the variable.

Table 2. Background characteristics of study participants, and possible predictors: participants with vs. without engagement problems listed as a barrier.

Study group IPS (vs. work choice) 43 49 33 56 10 36 2¼3.11 1 ns

Engagement

problems ( Without engagement problems (

d

43.75 11.49 85

DOI: 12.1080/09638237.2017.1417556 Barriers to employment in SMI and CJI 5

Satisfaction with servicesa (MSD) Gender 3.450.74 3.320.83 3.700.46 t¼2.65 77 0.01

Male (vs. female)

Race 69 79 46 78 23 82 2¼0.20 1 ns

White (vs. other)

Marital status 26 30 17 29 9 32 2¼0.10 1 ns

Never married (vs. other)

Education 60 69 40 68 20 71 2¼0.12 1 ns

5High school (vs. other) Housing 35 40 23 39 12 43 2¼0.12 1 ns

Own apartment (vs. other) 50 57 35 59 15 54 2¼0.26 1 ns

Diagnosis 2¼6.46 2 0.04

Schizophrenia 46 53 26 44 20 71

Bipolar disorder 22 25 19 32 3 11

Other Substance use diagnosisa

19 22 14 24 5 18

Alcohol dependence or abuse 19 23 14 25 5 19 2¼0.33 1 ns

Drug dependence or abuse

Employment history 28 33 22 40 6 21 2¼2.86 1 ns

Any work in past 5 years 43 49 32 54 11 39 2¼1.70 1 ns

No of jobs in past 5 years (MSD) 0.981.21 0.951.11 1.041.43 t¼0.28 43 ns

Competitive job at any time Social

security statusa 83 95 57 97 26 93 2¼0.61 1 ns

SSI only (vs. other)

Criminal justice history 45 56 31 55 14 56 2¼0.00 1 ns

Incarcerated (vs. not)a

Seriousness of convictionsa

68 78 49 83 19 68 2¼2.57 1 ns

Felony (vs. no) 54 64 41 71 13 48 2¼4.04 1 0.04

Misdemeanor (vs. no) Recovery assessment (baseline) (MSD)

58 70 41 71 17 68 2¼0.06 1 ns

Personal confidence and hope 4.070.64 4.010.67 4.190.58 t¼1.28 85 ns

Goal and success orientation 4.340.62 4.250.67 4.510.46 t¼1.84 85 ns

Willingness to ask for help 4.310.66 4.270.66 4.400.69 t¼0.87 85 ns

Reliance on others 4.140.62 4.110.64 4.200.56 t¼0.67 85 ns

No domination by symptoms 3.390.88 3.220.83 3.750.89 t¼2.70 85 0.01 a Missing values ranged from 2 to 7 responses. SSI: Supplemental Security Income. 0.01 (indicated in bold) is the p-value of the t-test for the variables. 0.04 (indicated in bold) is the p-value of the chi square test for the variables.

Barriers and criminal justice history

While common barriers to competitive employment in various

groups with mental illness without regard to CJI include

mental and physical illness, substance abuse, demographic

factors, stigma, as well as engagement and motivation

problems (Bassett et al., 2001; Braitman et al., 1995; Cook,

2006; Hanisch et al., 2017; Henry & Lucca, 2004; Kukla et al.,

2016; Milfort et al., 2015; Noel et al., 2017; Poremski et al.,

2016; Rosenheck et al., 2006; Tschopp et al., 2007), the current

study focused specifically on people with criminal justice

history, and hypothesized that barriers related to employers’

acceptance of clients with CJI would be especially important

in this population. Surprisingly, employer resistance to

criminal justice history was rarely mentioned as a barrier. This

finding may be explained by barriers arising earlier in the

process, before achieving actual contact with employers.

Engagement problems

Engagement problems, including initial failure to engage in

services, or discontinued engagement from services after

initial participation, stood out as the most common and

important barriers across groups. This involved missed

meetings with failed attempts at outreach, and participants

missing from clinical, residential or vocational services.

Engagement problems were associated with being more

dominated by symptoms and being convicted of more serious

crimes, and participants with these problems were less

satisfied with the vocational services, with effect sizes in the

6 V. Sveinsdottir & G. R. Bond J Ment Health, Early Online: 1–9

small–medium range. There were also some differences in

diagnoses, though recent research suggests that functioning

may be of more specific importance to competitive

employment than diagnosis itself (Hanisch et al., 2017).

Showing less favorable characteristics related to recovery and

criminal background, underlying reasons for lack of

engagement among this group may be related to beliefs about

feasibility of attending services due to competing challenges,

and poor expected outcomes of participation.

Feasibility and competing challenges

Ability to keep appointments and commit to a program may be

challenged by difficult life situations commonly facing this

marginalized group. People with SMI and CJI take longer than

others to engage in employment discussions and receive

employment services than those without criminal

backgrounds, and qualitative research has highlighted how

employment may be viewed as secondary to more pressing

needs (such as finding permanent housing) and competing

challenges with the legal system for this group (Frounfelker et

al., 2010). Transportation can be challenging in large cities. In

the current study, participants were dispersed throughout the

city, which may have adversely affected attendance. Court and

probation services may furthermore restrict engagement by

enforcing strict monitoring and primarily being concerned

with whether participants violate their probation, rather than

facilitating job acquisition, and collaborating with mental

health and employment services.

Outcome expectancies

Lack of motivation to commit to employment services may

also be due to low expectations of these services being able to

provide the help that is needed. Studies have illustrated how

people with SMI and CJI feel hopeless and lack the conviction

that vocational programs could help them succeed at work

(Baron et al., 2013; Frounfelker et al., 2010). Unresponsive

services, previous negative experiences related to job-seeking,

lack of encouragement and social networks, and the impact

that the criminal history has had on other aspects of their lives,

may be generalized and lead to feelings of helplessness and

resignation, resulting in withdrawal from services. Such

helplessness, in terms of acquired beliefs that there is no

relationship between a response and reinforcement (Ursin &

Eriksen, 2004), illustrates a perceived lack of control that

would make efforts to engage appear futile. The expectancies

can thereby be self-fulfilling, in terms of preventing further

generation of new experiences to contradict such a notion.

Substance abuse

Aside from engagement problems, substance abuse was rated

as the third main barrier to employment. While being common

in other populations with SMI (Braitman et al., 1995; Kukla et

al., 2016; Poremski et al., 2016), substance use disorders are

highly prevalent within the criminal justice system (Kopak,

2015), and co-occurring mental and substance use disorders

represent a significant problem among this group (Peters et al.,

2008). Studies indicate that 72–87% of people with SMI and

CJI have substance use disorders, a double challenge that may

be related to demoralization and low motivation and

engagement in treatment (Peters et al., 2008). Considering the

zero-exclusion criterion in IPS, including clients regardless of

ongoing substance abuse, the finding that this was a common

barrier in this study is not surprising. People with co-occurring

disorders do however report a similar interest in employment

as clients without cooccurring disorders, and despite difficulty

accessing services, those enrolled show similar employment

rates (Frounfelker et al., 2011). Accordingly, providing access

to evidence-based employment services in spite of barriers

related to substance abuse, and not delaying employment by

waiting for treatment completion, is an important part of the

methodology in IPS.

Job goals

In spite of clear differences in the methodology of the

employment programs as well as their effect on competitive

employment, the only difference in barriers concerned the lack

of a competitive job goal, which was a more common problem

among participants in the work choice group.

Although all participants expressed a desire for competitive

employment at baseline, this barrier means that competitive

employment was no longer a goal as explicitly stated by the

participant. Specific features of the IPS condition may have

contributed to this finding. One is the principle of attention to

client preferences, meaning that decisions about work and

types of jobs to look for are individualized, taking the clients’

interests and preferences into consideration, and involving

them personally in the process. The intervention seeks to find

a good job match based on what the individual finds most

important in a job, combined with considerations of personal

skills, previous experiences and specific job conditions that

might contribute positively, rather than attempting to place a

person into any job that might be available. Moreover, the

principle of rapid job-search involves face-to-face employer

contact within a month of joining the program. The active and

personalized nature of the intervention, combined with the

focus on real-life jobs in the competitive labor market rather

than extensive pre-vocational preparation and training, is likely

to contribute to finding engaging job goals and maintaining the

interest in work.

Implications and the way forward

The existing research on IPS for people with SMI and CJI

shows that a significant number of clients do benefit from these

services and are able to obtain competitive work (Bond et al.,

2015; Frounfelker et al., 2011). But while this group faces

various social and statutory barriers to employment related to

their criminal history, the current study shows that main

barriers occur early in a job search process, in many cases

before even attempting contact with potential employers.

The results call for recognition and awareness of

motivational issues in the vocational rehabilitation of this

DOI: 12.1080/09638237.2017.1417556 Barriers to employment in SMI and CJI 7

patient group. Efforts to actively include participants in the

rehabilitation process are especially important within this

context. As suggested by Lamberti (2016), this may be done

by combining best practices, and emphasizing engagement by

providing individualized services that involve clients directly

in addressing problem behaviors. This involves including the

client in a collaborative process with a common goal of being

healthy and independent from CJI (Lamberti, 2016). Although

IPS services share much of this focus, targeting active

involvement of clients and integrating employment services

with mental health treatment, our results indicate that the

specific challenges related to service engagement issues are

still not overcome.

This study suggests that IPS may be a starting point for

developing an effective employment model for people with

SMI and CJI, but augmentations may be needed to achieve

optimal employment outcomes. While employment specialists

involved in the current study received an additional day-long

training in criminal justice issues, a potential enhancement of

IPS specific to this population might be to develop IPS

specialty teams devoted exclusively to justiceinvolved clients.

Specialized teams may be better positioned to integrate with

treatment teams serving this population, and to coordinate

employment and treatment plans with the legal and

correctional systems. Necessary augmentations also include

providing staff with specific training in motivational strategies.

Techniques such as motivational interviewing have been

increasingly employed by service providers in various contexts

of health treatment and social work (Stanhope et al., 2016), and

training clinicians in motivational interviewing to address their

own as well as patients’ motivational conflicts has been shown

to increase employment outcomes among clients receiving IPS

(Craig et al., 2014).

Experiences from an earlier pilot program at the psychiatric

rehabilitation organization involved in this study, which

assigned an employment specialist to a treatment team for

justice involved clients, furthermore provides some useful

insights. Employment rates were low during the first year,

improving to 44 to 47% in the second year, suggesting that

start-up issues may be especially challenging in working with

this population. The employment specialist attributed her

success to gradual relationship-building and collaboration with

the clinical team to address more pressing priorities before

initiating job searches, thereby deferring the rapid job search

principle of IPS, in accord with following client preferences.

Conclusions

Problems related to engagement in services were the main

barriers to competitive employment among people with SMI

and CJI, and were evident across study groups. The results

highlight the importance of attention to motivational issues and

factors that may inhibit engagement in the rehabilitation

process of this group. The use of specialized IPS teams

devoted to justice-involved clients, with training in techniques

that specifically target motivational conflicts and engagement

barriers, could be a necessary augmentation to services offered

to people with SMI and CJI.

Acknowledgements

We thank Izabela M. Krzos, Carla M. Elliott, Sheila O’Neill

and Ginnie Fraser at Thresholds, for their assistance in data

collection and handling. We would also like to thank all the

individual service providers who reviewed the rosters and

registered barriers for all their clients enrolled in the study.

Declaration of interest

The authors report no conflicts of interest.

Funding

The data used in this study was collected in research supported

by grant H133G100110 from the National Institute on

Disability and Rehabilitation Research 10.13039/100006663.

ORCID

Vigdis Sveinsdottir http://orcid.org/0000-0002-9776-4925

References

Anderson DB, Schumacker RE. (1986). Assessment of job training

programs. J Offender Rehabil, 10, 41–9. Azrin NH, Philip RA. (1979). The Job Club method for the

jobhandicapped: A comparative outcome study. Rehabil Counsel Bull,

23, 144–55. Baron RC, Draine J, Salzer MS. (2013). ‘‘I’m not sure that I can figure

out how to do that’’: Pursuit of work among people with mental

illnesses leaving jail. Am J Psychiatr Rehabil, 16, 115–35. Bassett J, Lloyd C, Bassett H. (2001). Work issues for young people with

psychosis: Barriers to employment. British J Occup Ther, 64, 66–72.

Becker DR, Drake RE, Bond GR. (2014). The IPS supported employment

learning collaborative. Psychiatr Rehabil J, 37, 79–85. Bellotti J, Derr M, Paxton N. (2008). Giving ex-offenders a choice in life:

First findings from the Beneficiary Choice Demonstration. Princeton,

NJ: Mathematica Policy Research. Blumstein A, Nakamura K. (2009). Redemption in the presence of

widespread criminal background checks. Criminology, 47, 327–59. Bond GR, Drake RE. (2014). Making the case for IPS supported

employment. Adm Policy Ment Health, 41, 69–73. Bond GR, Drake RE, Becker DR. (2012). Generalizability of the

Individual Placement and Support (IPS) model of supported

employment outside the US. World Psychiatr, 11, 32–9. Bond GR, Kim SJ, Becker DR, et al. (2015). A controlled trial of

supported employment for people with severe mental illness and justice

involvement. Psychiatr Serv, 66, 1027–34. Braitman A, Counts P, Davenport R, et al. (1995). Comparison of barriers

to employment for unemployed and employed clients in a case

management program: An exploratory study. Psychiatr Rehabil J, 19,

3–8. Cook JA. (2006). Employment barriers for persons with psychiatric

disabilities: Update of a report for the President’s commission.

Psychiatr Serv, 57, 1391–405. Corrigan PW, Reedy P. (1995). Correlates of participation and completion

in a job club for clients with psychiatric disability. Rehabil Counsel

Bull, 39, 42–53.

8 V. Sveinsdottir & G. R. Bond J Ment Health, Early Online: 1–9 Corrigan PW, Salzer M, Ralph RO, et al. (2004). Examining the factor

structure of the recovery assessment scale. Schizophr Bull, 30, 1035–

41. Craig T, Shepherd G, Rinaldi M, et al. (2014). Vocational rehabilitation

in early psychosis: Cluster randomised trial. British J Psychiatr, 205,

145–50. Drake RE, Bond GR, Becker DR. (2012). Individual placement and

support: An evidence-based approach to supported employment. New

York, USA: Oxford University Press. Drake RE, McHugo GJ, Becker DR, et al. (1996). The New Hampshire

study of supported employment for people with severe mental illness.

J Consult Clin Psychol, 64, 391–19. Drake RE, Mueser KT, McHugo GJ. (1996). Clinician rating scales:

Alcohol Use Scale (AUS), Drug Use Scale (DUS), and Substance

Abuse Treatment Scale (SATS). In L. I. Sederer & B. Dickey eds.

Outcomes assessment in clinical practice. Baltimore: Williams &

Wilkins, 113–6. Finn P. (1998). Program focus: Chicago’s safer foundation: A road back

for ex-offenders. Washington, DC: U.S. Department of Justice, Office

of Justice Programs, National Institute of Justice. Frounfelker RL, Glover CM, Teachout A, et al. (2010). Access to

supported employment for consumers with criminal justice

involvement. Psychiatr Rehabil J, 34, 49–56. Frounfelker RL, Teachout A, Bond GR, Drake RE. (2011). Criminal

justice involvement of individuals with severe mental illness and

supported employment outcomes. Community Ment Health J, 47, 737–

41. Frounfelker RL, Wilkniss SM, Bond GR, et al. (2011). Enrollment in

supported employment services for clients with a co-occurring

disorder. Psychiatr Serv, 62, 545–7. Hamilton R, McKinney KC. (1999). Job Training for Juveniles: Project

CRAFT. Washington, DC: U.S. Department of Justice, Office of

Justice Programs, Office of Juvenile Justice and Delinquency Prevention.

Hanisch SE, Wrynne C, Weigl M. (2017). Perceived and actual barriers

to work for people with mental illness. J Voc Rehabil, 46, 19–30. Harrison B, Schehr RC. (2004). Offenders and post-release jobs:

Variables influencing success and failure. J Offender Rehabil, 39, 35–

68. Henry AD, Lucca AM. (2004). Facilitators and barriers to employment:

The perspectives of people with psychiatric disabilities and

employment service providers. Work, 22, 169–82. Holzer HJ, Raphael S, Stoll MA. (2003). The urban institute reentry

roundtable discussion paper: Employment barriers facing ex-offenders.

New York: New York University Law School. Kopak AM. (2015). Breaking the addictive cycle of the system:

Improving US criminal justice practices to address substance use

disorders. Int J of Prison Health, 11, 4–16. Kukla M, McGuire AB, Salyers MP. (2016). Barriers and facilitators

related to work success for veterans in supported employment: A

nationwide provider survey. Psychiatr Serv, 67, 412–17. Lamberti JS. (2016). Preventing criminal recidivism through mental

health and criminal justice collaboration. Psychiatr Serv, 67, 1206–12. LePage JP, Lewis AA, Washington EL, et al. (2013). Effects of structured

vocational services in ex-offender veterans with mental illness: 6-

month follow-up. J Rehabil Res Dev, 50, 183–92. Mallar CD, Thornton CVD. (1978). Transitional aid for released

prisoners: Evidence from the life experiment. J Hum Resour, 13, 208–

36. Marshall T, Goldberg RW, Braude L, et al. (2014). Supported

employment: Assessing the evidence. Psychiatr Serv, 65, 16–23. Menon R, Blakely C, Carmichael D, Silver L. (1992). An evaluation of

project rio outcomes: An evaluative report. College Station, TX: A&M

University, Public Policy Resources Laboratory. Milfort R, Bond GR, McGurk SR, Drake RE. (2015). Barriers to

employment among social security disability insurance beneficiaries in

the mental health treatment study. Psychiatr Serv, 66, 1350–2. Morris MW, Sumner M, Borja JZ. (2008). A higher hurdle: Barriers to

employment for formerly incarcerated women. Berkeley, CA:

University of California. Noel VA, Oulvey E, Drake RE, Bond GR. (2017). Barriers to employment

for transition-age youth with developmental and psychiatric

disabilities. Adm Policy Ment Health, 44, 354–8. Peters RH, Bartoi MG, Sherman PB. (2008). Screening and assessment of

co-occurring disorders in the justice system. Delmar, NY: CMHS

National GAINS Center. Poremski D, Woodhall-Melnik J, Lemieux AJ, Stergiopoulos V. (2016).

Persisting barriers to employment for recently housed adults with

mental illness who were homeless. J Urban Health, 93, 96–108. Prins SJ. (2014). Prevalence of mental illnesses in US State prisons: A

systematic review. Psychiatr Serv, 65, 862–72. Redcross C, Millenky M, Rudd T, Levshin V. (2012). More than a job:

Final results from the evaluation of the Center for Employment

Opportunities (CEO) Transitional Jobs Program. Retrieved from New

York, NY:. Rosenheck R, Leslie D, Keefe R, et al. (2006). Barriers to employment

for people with schizophrenia. Am J Psychiatry, 163, 411–17. Rossi PH, Berk RA, Lenihan KJ. (1980). Money, work, and crime:

Experimental evidence. New York: Academic Press. Rossman, S., Sridharan, S., Gouvis, C, et al. (1999). Impact of the

opportunity to succeed (OPTS) aftercare program for substance-

abusing felons: Comprehensive final report. Washington, DC.

Available from:

https://www.ncjrs.gov/pdffiles1/nij/grants/181046.pdf. Sabol W. (2007). Local labor-market conditions and post-prison

employment experiences of offenders released from ohio state prisons.

In: S. Bushway, M. A. Stoll, & D. A. Weiman, eds. Barriers to reentry?

The labor market for released prisoners in post-industrial America.

New York: Russell Sage Foundation, 257–303. Schaeffer CM, Henggeler SW, Ford JD, et al. (2014). RCT of a promising

vocational/employment program for high-risk juvenile offenders. J

Subst Abuse Treat, 46, 134–43. Schochet P, Burghardt J, Glazerman S. (2001). National Job Corps Study:

The impacts of Job Corps on participants’ employment and related

outcomes. Princeton, NJ. Available from:

http://wdr.doleta.gov/research/FullText_Documents/01-jcimpacts.pdf. Sevak P, Khan S. (2017). Psychiatric versus physical disabilities: A

comparison of barriers and facilitators to employment. Psychiatr

Rehabil J, 40, 163–71. Solinas-Saunders M, Stacer MJ, Guy R. (2015). Ex-offender barriers to

employment: Racial disparities in labor markets with asymmetric

information. J Crime Justice, 38, 249–69. Solomon AL, Johnson KD, Travis J, McBride EC. (2004). From prison to

work: The employment dimensions of prisoner reentry. A report of the

Reentry Roundtable. Retrieved from Washington, DC. Stanhope V, Tennille J, Bohrman C, Hamovitch E. (2016). Motivational

interviewing: Creating a leadership role for social work in the era of

healthcare reform. Soc Work Public Health, 31, 474–80. Theriot MT, Segal SP. (2005). Involvement with the criminal justice

system among new clients at outpatient mental health agencies.

Psychiatr Serv, 56, 179–85. Thornicroft G. (2006). Shunned: Discrimination against people with

mental illness. New York: Oxford University Press. Tonkin P, Dickie J, Alemagno S, Grove W. (2004). Women in jail. J

Offender Rehabil, 38, 51–71. Tschopp MK, Perkins DV, Hart-Katuin C, et al. (2007). Employment

barriers and strategies for individuals with psychiatric disabilities and

criminal histories. J Voc Rehabil, 26, 175–87. Tschopp MK, Perkins DV, Wood H, et al. (2011). Employment

considerations for individuals with psychiatric disabilities and criminal

histories: Consumer perspectives. J Voc Rehabil, 35, 129–41. Uggen C. (2000). Work as a turning point in the life course of criminals:

A duration model of age, employment, and recidivism. Am Soc Rev,

65, 529–46. Ursin H, Eriksen HR. (2004). The cognitive activation theory of stress.

Psychoneuroendocrinology, 29, 567–92.

DOI: 12.1080/09638237.2017.1417556 Barriers to employment in SMI and CJI 9

Appendix

A. Barriers to Employment Checklist Visher C, Winterfield L, Coggeshall M. (2005). Ex-offender employment

programs and recidivism: A meta-analysis. J Exp Criminol, 1, 295–

316.

Walter RJ, Caudy M, Ray JV. (2016). Revived and discouraged:

Evaluating employment barriers for section 3 residents with criminal

records. Housing Policy Debate, 26, 398–415. Whitley R, Kostick KM, Bush PW. (2009). Supported employment

specialist strategies to assist clients with severe mental illness and

criminal justice issues. Psychiatr Serv, 60, 1637–41. Justice Involvement Study Barriers to Employment Checklist

Members Name: Review Period: _____________ ___________ ________________ ___________

Raters Name:______ ____________ _________ Date: _____________ _____________ _________

Instructions: For each study participant, indicate the three top barriers to employment, indicating 1, 2, and 3 for the 1st, 2nd, and 3rd most important

barrier, respectively. OK to list fewer than 3 barriers. Raters provide information in the documentation section as to how the barrier interfered with

obtaining employment. Refer to the description of barriers on the previous page to determine rankings.

Barrier # 1 Documentation

Barrier # 2 Documentation

Barrier # 3 Documentation

Barrier Barrier Description

1. Failure to Engage in Voc Services A) Competitive employment is no longer the goal-explicitly stated by member

B) Documentation of missed meetings, outreach attempts made with no

engagement

2. Disengagement from Voc Services Refers to a member that began vocational services was engaged and later discontinued participation because:

A) Competitive employment is no longer the goal-explicitly stated by member B) Member is missing from clinical, residential or vocational services

3. Physical Health Problems Not Controlled Documentation of physical health problems- as observed by clinical and vocational staff

Evidence that physical health problems are a barrier to obtaining employment

4. Substance Abuse/Dependence Not Well Controlled Documentation of substance use

5. Symptoms of Mental Illness Not Well Controlled Refers to symptoms that interfere with the ability to engage in services (ex. Persecutory

delusions that prevent member from attending job club group)

6. Cognitive Problems (including Literacy) 7. Family Problems Any family problems that interfere with the ability to engage in voc services (ex. Death

in family, taking care of elderly or sick family member)

8. Gap in Services (e.g. Case Management) Refer to any period of time that a member was no receiving vocational services because

of staff turnover and no replacement vocational staff is available

9. Transportation This item is to be rated by the treatment team. Transportation issue includes inability to

orient oneself with public transportation routes/schedules and in turn preventing the

member from reaching destination for services. This does not refer to member not

wanting to take public transportation or lack of funds to pay for transportation since

bus cards were provided to get to all study related meetings.

10. Lack of pre-requisites for work Ex. Lack of high school diploma, lack of required certification

11. Lack of Social Skills Ex. Member stated s/he doesn’t like people

12. Criminal Justice System Problems 13. Housing Problems Refers to homelessness. This item does not include members dislike with current

housing situation and loss of interest in finding work until new housing is found

10 V. Sveinsdottir & G. R. Bond J Ment Health, Early Online: 1–9

14. Behavior Problems Fights, banned from attending thresholds program locations

15. Benefits 16.

Don’t know A) member does not want to work for fear of losing financial and health care benefits B)

member has debt that would be deducted from SSA check if s/he began working